tdiu Kidney Transplant And Subsequent Va Proposal To Reduce Rating

[vaf]

The veteran underwent a medical discharge after nine years active duty, due to kidney failure. He underwent a transplant in 1998, and was supposed to undergo a follow-up C & P in 1999, which didn't take place until earlier this year. He was rated 100% until now, having received a proposal to reduce down to the minimum, which is 30%. He works full-time in an office job, sedentary work, and does not want to or have a need to pursue TDIU. However, he is suffering secondary effects from the immunosuppressant drugs (has had skin cancer, has GERD, and a suspected but yet undiagnosed case of sleep apnea), has had his gall bladder removed, all which was not in place before the surgery, and which have not been claimed separately, and therefore, not rated. He receives his treatment from the VA.

We've requested his records from the VAMC and the VARO, however, we won't see his claims file anytime soon, probably not before his hearing (he's filed an NOD and asked for a hearing).

I'm wondering if anyone here has successfully fought a proposal to reduce a disability rating post-kidney transplant, after five or more years have passed since the surgery, who is not TDIU. If so, I'd be interested to hear how you handled the NOD and how you framed your argument. Thanks!

[Captain D]

Hello everyone, I am new here. Thank you for all of the valuable information. Here is my case. I was in the Marine Corps and then the Army.  When I came back on active duty for the Army it was found out that I had some kidney issues. I was finally diagnosed with an autoimmune disease known as FSGS. I was subsequently discharged later that year in 1999. I received disability rating from the Army at 80%. I filed with the VA and received 100% IU.  Early 2002 I was put on dialysis. Later that year I received a kidney transplant from my older brother(also a Marine) from the National Institutes of Health. The VA never scheduled me for any exams. In 2009 I moved and never received the financial form that you have to fill out for Individual Unemployability. They stop my benefits and I contacted them and they told me why. I even drove hundreds of miles to the regional office in Florida. I finally reovered my 100% rating later that year. In 2013 I had a baby. My current wife and I were not married at the time, but subsuqsequently go married about a year later in 2014. I filed with the VA for dependant benifits for my daughter back to her birth in 2013 and for my wife and stepson from the date of marriage. Unfortunately,  I started going into end stage renal failure again due to the same disease, FSGS. So I decided in March of 2015 to file for Permanent and Total Disability, so that i could get Champ VA for my family.  I filed all the claims thru ebenfits. I recently received another kidney tranplant in Feb of this year (about 2 months ago). I also recevied a letter from the VA compensationa and penison that I was scheduled for a evalution which I went to on 3/28/16. 

After reading all of your comments, I am unsure if I did the right thing by filing for P&T.  I do not want to get reduced to 30%. As one gentlemen put it, A transplant is not an imporovement of End stage renal failure. My kidneys apparently don't work, and now I have 2 in my adominal area. My claim was based on the recurring FSGS and that now that it came back and has caused ESKD again it has shown it is unlikely to improve. I also am thinking to open up a claim for hypertension since that is normally what you always have after ESKD. My question is how do I get a protected rating so I don't have to go thru this crap with the VA anymore? Also, are there any other claims I should put in post transplant, like side effects from medicines so if they reduce me I could somehow have a combined 100% rating for P&T?  I currently take 2 immunosuprresants and prednisone for anti rejection. I have not been able to sleep due to the prednisone. Have been severely dehydrated becasue kidney is over producing urine, night sweats, tremors due to high dose of prograf, etc.

 

Thank you.

[Berta]

Was the C & P done at a VAMC or farmed out to a contractual doctor?

If it was done at a VAMC you can get a copy of it, and their Records access officer might have a simple form you can sign, for it, and if you can scan and attach the exam results here we could better understand if you need more evidence...(cover c file # name prior to scanning it)

I think they post  C & Ps at ebenefits but am not sure if that is just the ones done at a VAMC.

You can join ebenefits if you haven't yet.

I cant imagine any C & P doctor would find that your condition could possibly improve based on what you said but I am not a doctor and the VA doesn't care what I think.

You might get a favorable C & P as to the P & T status but if not you might have to consider obtaining an IMO (Independent Medical Opinion)

If the CHAMPVA depends on the IMO , that might be the best investment you can make because CHAMPVA is wonderful.

Was the second transplant done by a non VA hospital? Perhaps you could attempt to get a free IMO or low cost one ,from the doctor who did it. We have the IMO criteria here under a search .

You deal with a lot. I assume you get SSDI for this condition as well. ?

 

 

 

[Captain D]

Thank you Berta for your response. The C&P WAS done at a VAMC. Once she has compiled all of the info and submitted it, I will attach it here.  I will also check ebenefits next week to see if it is there.  The second transplant was not done at the VA. It was done at Miami Transplant Institute.  I may try to have my nephrologist give me an indepent IMO as well.  I tried to apply ofr SSDI but they said I did not qualify because I did not have enough credits within the last 5 years.

[Berta]

How could you even obtain work credits with this disability????

Was the SSA denial based on evidence within the time period that VA had dropped your disability % rating ,but that you got back again to 100%?

Was that a formal written denial or what someone told you by phone from the SSA?

[halos2]

Sorry to read this vets dilema. Glad you had him file for a hearing...especially since they would sever in 30 days had it not be requested. Good move vaf. I am hoping someone else with experience in transplant claims can assist you in your endeavors to help this vet. Good luck.

The veteran underwent a medical discharge after nine years active duty, due to kidney failure. He underwent a transplant in 1998, and was supposed to undergo a follow-up C & P in 1999, which didn't take place until earlier this year. He was rated 100% until now, having received a proposal to reduce down to the minimum, which is 30%. He works full-time in an office job, sedentary work, and does not want to or have a need to pursue TDIU. However, he is suffering secondary effects from the immunosuppressant drugs (has had skin cancer, has GERD, and a suspected but yet undiagnosed case of sleep apnea), has had his gall bladder removed, all which was not in place before the surgery, and which have not been claimed separately, and therefore, not rated. He receives his treatment from the VA.

We've requested his records from the VAMC and the VARO, however, we won't see his claims file anytime soon, probably not before his hearing (he's filed an NOD and asked for a hearing).

I'm wondering if anyone here has successfully fought a proposal to reduce a disability rating post-kidney transplant, after five or more years have passed since the surgery, who is not TDIU. If so, I'd be interested to hear how you handled the NOD and how you framed your argument. Thanks!

[broncovet]

I do not know anything about transplants, however the regulations state the VA must show that the SC condition has improved for a reduction in benefits to happen. How do you "improve" from a transplant?

Do you become "un transplanted"? I dont think so. Generally, I would suggest writing a letter stating that the Veterans condition has not improved, he continues to receive treatment from a transplant. JMHO

Edited August 21, 2009 by broncovet